Provider Demographics
NPI:1982993028
Name:ORR, BRANDON J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:J
Last Name:ORR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16708 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6345
Practice Address - Country:US
Practice Address - Phone:425-316-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI57738-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program